Department of Medicine, Division of Gastrointestinal Medical Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York, USA.
Cancer. 2012 Jun 15;118(12):3053-61. doi: 10.1002/cncr.26600. Epub 2011 Oct 11.
Pancreatic adenocarcinoma is among the most common malignancies associated with thromboembolic events (TEs); however, reported incidence figures vary significantly and contain small patient cohorts. Pancreatic cancer-specific thrombosis studies examining the correlation between clinical variables, including thrombosis timing and the impact of thrombosis on survival, have not been reported.
Survival analyses were performed relating to the development and timing of a TE in 1915 patients administered chemotherapy at Memorial Sloan-Kettering Cancer Center with invasive exocrine pancreatic cancer from January 1, 2000 to December 31, 2009. TE timing, relative to clinical parameters including laboratory data, erythropoietin-stimulating agent use, and body mass index (BMI), were also analyzed.
A thrombosis was identified in 690 (36%) patients. After adjusting for patients with pancreatic surgery and thrombosis (n = 127), developing a TE significantly increased the risk of death (hazard ratio [HR], 2.6; 95% confidence interval [CI], 2.3-2.8; P < .01). Patients with an early TE (within 1.5 months from pancreatic cancer diagnosis) had a significantly higher risk of death (HR, 2.1; 95% CI, 1.7-2.5; P < .01) compared with patients with late TE or no TE. Erythropoietin-stimulating agent use and an elevated international normalized ratio were associated with significantly shorter time to thrombosis. Low BMI was associated with significantly longer time to thrombosis.
TEs are common in exocrine pancreatic cancer, with coagulopathy, erythropoietin-stimulating agent use, and underweight BMI influencing thrombosis timing. TEs, particularly early ones, confer a significantly worse prognosis, suggesting a biological significance, underscoring the relevance of ongoing prophylaxis trials, and raising the question of whether early TEs should be considered a stratification factor for clinical trials.
胰腺癌是最常见的与血栓栓塞事件（TEs）相关的恶性肿瘤之一；然而，报告的发病率数据差异很大，且包含的患者队列较小。尚未报道专门针对胰腺癌血栓形成的研究，这些研究检查了包括血栓形成时间和血栓形成对生存的影响在内的临床变量之间的相关性。
对 1915 例在 Memorial Sloan-Kettering 癌症中心接受化疗的侵袭性外分泌胰腺癌患者的 TE 发展和时间进行生存分析，这些患者的癌症确诊时间为 2000 年 1 月 1 日至 2009 年 12 月 31 日。还分析了 TE 时间与包括实验室数据、促红细胞生成素刺激剂使用和体重指数（BMI）在内的临床参数之间的关系。
在 690 例（36%）患者中发现了血栓形成。在调整了接受胰腺手术和血栓形成的患者（n=127）后，发生 TE 显著增加了死亡风险（风险比[HR]，2.6；95%置信区间[CI]，2.3-2.8；P<0.01）。与晚期 TE 或无 TE 患者相比，早期 TE（从胰腺癌诊断后 1.5 个月内）患者的死亡风险显著更高（HR，2.1；95%CI，1.7-2.5；P<0.01）。促红细胞生成素刺激剂的使用和国际标准化比值升高与血栓形成时间显著缩短相关。低 BMI 与血栓形成时间显著延长相关。
TEs 在胰腺外分泌癌中很常见，凝血功能障碍、促红细胞生成素刺激剂的使用和体重过轻的 BMI 会影响血栓形成时间。TEs，特别是早期 TEs，预后显著更差，这表明其具有生物学意义，突显了正在进行的预防试验的相关性，并提出了一个问题，即早期 TEs 是否应被视为临床试验的分层因素。
